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Methods of interpreting pulmonary gas exchange



Methods of interpreting pulmonary gas exchange



Der Anaesthesist 42(1): 3-10



When arterial and mixed venous blood gas tensions, inspired and expired O2 and expired CO2 concentrations are known, it is possible to calculate the alveolar-arterial PO2 difference, intrapulmonary right-to-left shunt and dead space ventilation. However, because arterial hypoxemia is caused by ventilation/perfusion mismatching in most cases, a method allowing analysis of ventilation/perfusion ratios is needed. The "multiple inert gas elimination technique" (MIGET) is a powerful method that is useful for this purpose. This technique is based on measurements of arterial, venous and expired levels of inert gases spanning a wide range of solubility and analysis of the lung for the ventilation/perfusion ratios from true shunt to dead space ventilation. True shunt, with ventilation/perfusion ratios of 0, can be differentiated from ventilation/perfusion ratios of 0.005, and dead space ventilation can be distinguished from ventilation/perfusion ratios over 10 and under 100. Ventilation/perfusion ratios between these extremes can also be differentiated. It is not unusual for results yielded by MIGET to differ from those obtained with O2-dependent methods: O2 shunt generally exceeds MIGET shunt, for example, because O2 shunt includes low ventilation/perfusion units.

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PMID: 8447570


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